KU Care Team Emergency Funding Request

Emergency Funding Request Information

Amount of Request:

Applicant Information

First and Last Name

KU ID Number

Phone number

KU Email address

Address (street, city, state, zip)

Questions

Please answer the following questions and provide as much detail as possible. Some questions may not apply to your situation but it helps us to determine the appropriate funding source, should your request be approved.

What is your emergency situation? Please describe your emergency in detail (e.g., lost job, parents lost job, disaster, etc).(Required) This field is required.

How does this emergency affect your academic success and/or ability to be in school?(Required) This field is required.

Please list the expense(s) for which you are requesting emergency funding (e.g.,food, books, rent, etc). Include amounts for each and documentation of the expense (e.g., rent agreement, receipt for books).(Required) This field is required.

Please describe your current job situation.(Required) This field is required.

What have you done to get additional money from other places, such as work, loans (student, private, or Parent Plus), parents/family, government assistance, etc.?(Required) This field is required.

Do you or your family receive SNAP benefits (food stamps)?(Required)

Yes No

This field is required.

Please check the following, acknowledging your understanding and permission:(Required)

I certify that all information provided above is correct to the best of my knowledge. I give permission for KU Care Team member to verify my academic record, student account, and financial aid information at KU. I give permission for a KU Care Team member to verify my attendance and progress with my current KU faculty, if necessary.

You must make at least one selection.

If your request for funding is approved, you can choose to have the funds applied to your KU student account (Option 1); refunded to you through the refund method you have in place with the university (Option2); or have some funds applied to your account to satisfy your bill and some refunded to you for other expenses (Option 3). The option you choose for receiving funds will have no bearing on your your eligibility for funding or the decision made on your request. Option 1 is the easiest and fastest way apply funding to your KU student bill balance. Please select only ONE option for release of any funds awarded to you:(Required)

OPTION 1: Please apply any emergency funds awarded to my KU student account. I understand that the funds will be applied to outstanding charges in my account and that I will not receive any money directly unless the amount of the award exceeds the balance due on my account. I further understand that choosing this option will have no impact on my eligibility for emergency funding. OPTION 2: Please disburse any emergency funds awarded directly to me through the refund method I have in place through the university. I understand that I am responsible for paying any charges that remain on my KU account myself after I receive the award. I further understand that choosing this option will have no impact on my eligibility for emergency funding. Option 3: Please apply funding awarded to pay my bill directly to my KU student account and refund the award for my other emergent needs to me through the refund method I have in place at the university. I understand that choosing this option will have no impact on my eligibility for emergency funding.

This field is required.

Supporting Documentation

Documentation of your emergency expenses will help the processing of your request (e.g., receipts, invoices, and/or billing statements). All receipts should clearly identify the expense and have the name and address of the company to which the payment is owed/was made. You may also submit other documentation, such as lost wages, etc. (If available), to support your request for emergency funding. Please attach documentation here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Emergency Funding Request Information

Applicant Information

Questions

Supporting Documentation

Submission